Spine imaging helps predict future osteoporotic fracture risk

Regardless of BMD, spinal radiographs could serve as an independent predictor of future vertebral fractures.

WASHINGTON — Combining bone mineral density measurements and radiographs of the spine can help predict a patient’s risk for developing future postmenopausal osteoporotic spinal fractures, according to a new analysis of patients from two osteoporosis studies.

Ethel Siris, MD, an endocrinologist at Columbia-Presbyterian Medical Center, New York City, and colleagues reviewed data from the placebo groups included in the Fracture Prevention Trial — the pivotal trial for Forteo (teriparatide injection) — and in the Multiple Outcomes of Raloxifene Evaluation (MORE) study, which was the key trial for Evista (raloxifene hydrochloride). The analysis included 2651 postmenopausal women, of whom 1181 had prevalent vertebral fractures, according to a press release from Eli Lilly and Co., the sponsor of the study and maker of the drugs.

Siris, a member of the Orthopedics Today Editorial Advisory Board, presented the results of the new analysis at the National Osteoporosis Foundation’s Sixth International Symposium on Osteoporosis, held here.

The researchers found that regardless of BMD, the results of spinal radiographs could serve as an independent predictor of future vertebral fractures. For any given BMD, patients who had one or more prevalent radiographic vertebral fractures had an approximate three- to 11-times greater risk for developing a new vertebral fracture, according to the press release.

Furthermore, greater numbers and a higher severity of fractures were associated with increased risks for subsequent fractures. Two fractures yielded an approximate fivefold increase, and three or more fractures yielded an approximate sevenfold to eightfold increase.

The researchers also found that higher semiquantative deformity (SQ) scores and higher spinal deformity index (SDI) scores were both associated with increased risks for future fractures, as follows:

an SQ score of 2 yielded an approximate fivefold increase;
an SQ score of 3 yielded an approximate eightfold to tenfold increase;
an SDI score of 1 to 3 yielded an approximate threefold increase;
an SDI score of 4 to 6 yielded an approximate sixfold to sevenfold increase; and
an SDI score of 7 or higher yielded an approximate ninefold to elevenfold increase.